2015 Nevada Revised Statutes
Chapter 449 - Medical Facilities and Other Related Entities
NRS 449.610 - Form of declaration directing physician to withhold or withdraw life-sustaining treatment.

A declaration directing a physician to withhold or withdraw life-sustaining treatment may, but need not, be in the following form:

DECLARATION

If I should have an incurable and irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of my attending physician, cause my death within a relatively short time, and I am no longer able to make decisions regarding my medical treatment, I direct my attending physician, pursuant to NRS 449.535 to 449.690, inclusive, to withhold or withdraw treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain.

If you wish to include this statement in this declaration, you must INITIAL the statement in the box provided:

Withholding or withdrawal of artificial nutrition and hydration may result in death by starvation or dehydration. Initial this box if you want to receive or continue receiving artificial nutrition and hydration by way of the gastrointestinal tract after all other treatment is withheld pursuant to this declaration.

[............................................ ]

Signed this ........………...... day of ..…..........., ......

Signature..........................................................

Address.............................................................

The declarant voluntarily signed this writing in my presence.

Witness.............................................................

Address.............................................................

Witness.............................................................

Address.............................................................

(Added to NRS by 1977, 760; A 1991, 633; 1993, 2790)